The symptoms and signs of spondylotic cervical myelopathy (SCM) in the elderly are variable, but an ataxic-spastic gait disturbance combined with tingling in the finger tips and clumsy hands are often encountered. SCM is due to degenerative changes of discs and osseous and ligamentous structures with compression of the spinal cord. The symptoms, signs, surgical and conservative treatment, and outcome were retrospectively analyzed in 36 patients. Most of the patients undergoing surgery (n = 22) improved their clinical score and maintained this improvement for the period of observation; the non-operated patients (n = 14) had a very slow progression. Diagnostic difficulties and problems of the surgical and conservative approaches are discussed.